IG Report: Medicare Spent $32M on Questionable HIV Drugs

Medicare's prescription drug program in 2012 paid $32 million for questionable HIV medications to almost 1,600 beneficiaries, says a report from the Office of Inspector General of the Department of Health and Human Services.

The report on the program, known as Part D, was released Wednesday and says that in some cases there wasn't even any indication of HIV in the Medicare histories of those receiving money for the medications, or that recipients got an excessive dose or supply.

For example, the report says one 77-year-old Detroit woman allegedly filled $33,500 worth of prescriptions for 10 different HIV medications, though there's no record she had HIV or visited the doctors who wrote up the prescriptions.

Another case involved a New York beneficiary who got a 720-day supply of an HIV drug using two different pharmacies and two different doctors.

In another case, a 48-year-old recipient in Miami visited 28 different pharmacies to pick up HIV drugs worth nearly $200,000, almost 10 times what average patients get in a year. The prescriptions were purportedly written by 16 health providers.

In another jaw-dropping example, a patient in a single day got $17,500 of HIV drugs — but none the rest of the year. The report noted that the female patient received more than twice the recommended dose of five HIV drug ingredients.

National Public Radio reports the Part D program cost taxpayers about $65 billion in 2013, and that previous inspector general reports have criticized how Medicare oversees doctors and pharmacies.

The latest investigation, however, focuses on patients who allegedly abused the program, with more than half identified as lacking any diagnosis of HIV, no records of lab tests to monitor the use of the drugs, and no record of medical services from any of the doctors who were writing up the scripts, NPR reported.

The Wall Street Journal reported that recent research finds that when ritonavir—the active ingredient in the HIV drug Norvir—is mixed with certain illicit drugs, including ecstasy, it heightens the psychoactive effects of the drugs.

"These patterns may indicate that a beneficiary is receiving inappropriate drugs and diverting them for sale on the black market," the inspector general's report says.

"They may also indicate that a pharmacy is billing for drugs that a beneficiary never received or that a beneficiary's identification number was stolen."

The inspector general reports that in 2012, more than 135,500 beneficiaries received HIV drugs that were paid for by Medicare Part D and, on average, the program paid $20,989 per beneficiary for these drugs, totaling $2.8 billion for the year.

The report comes amid concerns that Medicare Part D has limited safeguards, making it particularly vulnerable to fraud, waste, and abuse. It makes recommendations for the Centers for Medicare and Medicaid Services to expand their oversight of how drugs are prescribed in the program – including limiting patients to a number of pharmacies where they can buy their HIV drugs.

The Hill reports the reform measure is already on Congress' radar, noting Florida Republican Rep. Gus Bilirakis and New Mexico Democratic Rep. Ben Ray Luján have co-sponsored a bill titled "The Medicare Part D Patient Safety and Drug Abuse Prevention Act of 2013," which would limit the number of pharmacies where beneficiaries who are at high risk for abuse can get their drugs.

A spokesman for the CMS told The Journal the agency "takes this problem seriously and is taking steps to protect Medicare beneficiaries and the Medicare Trust Fund from the harm and damaging effects associated with prescription drug fraud and abuse."